# DR KERRIE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033672100
- **Authorized official:** DR. KERRIE JONGENEELEN PSY.D. (CLINICAL PSYCHOLOGIST)
- **Authorized official phone:** (617) 372-5653

## Contact information

- **Practice address:** 10 HAWTHORNE PARK, CAMBRIDGE, MA 02138-2104
- **Practice address phone:** (617) 372-5653
- **Mailing address:** 405 CONCORD AVE UNIT 386, BELMONT, MA 02478-7818
- **Mailing address phone:** (617) 372-5653

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 103TF0000X | Family Psychologist | — | NULL | — |
| 103TF0000X | Family Psychologist | — | — | — |

## Other

- **Enumeration date:** 04/07/2019
- **Last updated:** 06/11/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 110138961 | — | MA |